Shirodhara and Abhyanga for better sleep, reduced mental stress, and improved heart rate variability: A case report

Abstract

Mental stress and insomnia are very common complaints nowadays among young individuals. Stress not only impacts mental well-being but it is also responsible for poor cardiac activity. A 32-year-old male patient having mental stress, anxiety, fatigue, and insomnia was managed with Ayurvedic External Therapy Module (AETM) having Shirodhara (~therapeutic oil streaming over the scalp), Sarvanga abhyanga (~therapeutic massage), and Sarvanga swedana (~sudation therapy) sessions of one hour duration daily for ten days. The patient was evaluated for cardiovascular and autonomic changes in Heart Rate Variability (HRV) by HRV camera smartphone application, Pittsburgh Sleep Quality Index (PSQI) for sleep quality, and Perceived Stress Scale (PSS) Score for mental stress. The results found excellent changes in HRV time domain and frequency domain, a decrease in low-to-high frequency ratio suggesting parasympathetic activation, a 46.15% reduction in global PSQI score, and a 55.56% reduction in PSS score. This case study suggests that AETM sessions are not only effective in decreasing mental stress and improving sleep quality, but it also improves cardiac parameters.

Full text

© 2023 Journal of Ayurveda Case Reports | Published by Wolters Kluwer - Medknow 45
Shirodhara
and
Abhyanga
for better sleep,
reduced mental stress, and improved heart rate
variability: A case report
Danish Javed, Sana Anwar1, Divya Gupta2, Yudhveer Dhama3
Abstract:
Mental stress and insomnia are very common complaints nowadays among young individuals.
Stress not only impacts mental well‑being but it is also responsible for poor cardiac activity.
A 32‑year‑old male patient having mental stress, anxiety, fatigue, and insomnia was managed with
Ayurvedic External Therapy Module (AETM) having Shirodhara (~therapeutic oil streaming over
the scalp), Sarvanga abhyanga (~therapeutic massage), and Sarvanga swedana (~sudation therapy)
sessions of one hour duration daily for ten days. The patient was evaluated for cardiovascular
and autonomic changes in Heart Rate Variability (HRV) by HRV camera smartphone application,
Pittsburgh Sleep Quality Index (PSQI) for sleep quality, and Perceived Stress Scale (PSS) Score for
mental stress. The results found excellent changes in HRV time domain and frequency domain, a
decrease in low‑to‑high frequency ratio suggesting parasympathetic activation, a 46.15% reduction
in global PSQI score, and a 55.56% reduction in PSS score. This case study suggests that AETM
sessions are not only effective in decreasing mental stress and improving sleep quality, but it also
improves cardiac parameters.
KEYWORDS: Brahmi, Insomnia, Mental health, Swedana
INTRODUCTION
Mental stress and insomnia are highly
prevalent disorders in educated modern
society.[1] As the trend of nuclear families is
increasing in society, issues such as family
arguments, domestic aggression, separation,
and suicides are increasing day by day.[2] Patients
with mental disorders such as depression,
stress, and anxiety are continuously increasing
in the Indian population.[3] Mental stress in
daily life progressively becomes the root cause
of serious mental disorders. Mental stress also
adversely affects cardiac functions. There are
more risks of cardiovascular diseases in anxious
and depressed patients.[4] Studies also suggest
that sudden cardiac death risks are increasing
among stressed younger generations.[5] The
importance of holistic approaches such as
lifestyle modications, vegetarian or organic
food, Ayurveda, and yoga for wellness are
now being realized more by the developing
world. Mental health and cardiac health are
interrelated, which was also depicted in ancient
texts of Ayurveda.[6] Contemporary treatment
of mental illness includes antidepressants,
anxiolytics, and psychedelic drugs. Nevertheless,
this is a common perception that these drugs
are habit‑forming and are having numerous
side effects.[7] There is a need to establish early
Ayurvedic interventions to manage the mental
and cardiac health of the individuals.
Ayurveda has described various external
therapies in the form of external oleation,
Abhyanga (~therapeutic massage),
Swedana (~sudation), local oil pouring like
Address for correspondence:
Dr.DanishJaved,
DepartmentofAyush,
AllIndiaInstuteof
MedicalSciences,Saket
Nagar,Bhopal‑432020,
MadhyaPradesh,India.
E‑mail:danish.ayush@
aiimsbhopal.edu.in
Submied:31‑May‑2022
Revised:04‑Mar‑2023
Accepted:13‑Apr‑2023
Published: 30‑Jun‑2023
DepartmentofAyush,
AllIndiaInstuteof
MedicalSciences(AIIMS),
Bhopal,1Department
ofCommunity&Family
Medicine,AIIMS,Bhopal,
2DepartmentofKaya
Chikitsa,RDAyurvedic
College,Bhopal,Madhya
Pradesh,3Government
AyurvedicDispensary,
Sonipat,Haryana,India
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DOI:
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How to cite this article: Javed D, Anwar S, Gupta D,
Dhama Y. Shirodhara and Abhyanga for better sleep, reduced
mental stress, and improved heart rate variability: A case
report. J Ayurveda Case Rep 2023;6:45-9.
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Case Report
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Javed, et al.: Shirodhara and Abhyanga improves mental and cardiac health
46 Journal of Ayurveda Case Reports - Volume 6, Issue 2, April-June 2023
Shirodhara (~therapeutic oil streaming over the scalp),
Sarvanga dhara (~therapeutic oil streaming over whole
body), Sthanika basti (~local therapeutic retention of oil),
etc. Shirodhara provides mental relaxation that results in a
dynamic psychosomatic balance.[8] Shirodhara is considered
equivalent to yogic meditation, in which generally a
medicated stream of uid is poured over forehead in
rhythmic fashion.[8]
Therapeutic steaming and massage with Ayurvedic
decoctions and oils are also an established therapy for
wellness. In the past few years, Ayurveda massage therapy has
attracted the particular attention of researchers throughout
the world. Previous studies in the last decade show the health
benets of Abhyanga and Swedana for well‑being.
In this case report, a subject having complaints of mental
stress and insomnia was treated with Ayurvedic External
Therapy Module (AETM), which includes administration
of Shirodhara, Sarvanga abhyanga and Sarvanga swedana for a
period of 10 days. A smartphone application Heart Rate
Variability (HRV) camera was used to monitor the changes
in HRV during Ayurvedic therapies. Encouraging results
were found on various HRV cardiovascular and autonomic
parameters, along with subjective improvement in scores
for stress and sleep [Perceived Stress Scale (PSS) and
Pittsburgh Sleep Quality Index (PSQI)], respectively.
PATIENT INFORMATION
A 32‑year‑old male patient with body weight of 54 kg,
height of 162 cm, and body mass index of 20.6 kg/m2 had
complaints of sleep disturbance and mental stress due to his
hectic schedule and having difculty focusing on his routine
work reported to the outpatient department for seeking
Ayurvedic consultation. He was apparently healthy with
no other acute or chronic illnesses. He had a lean and thin
physique, sharp face, dark complexion, normal straight dark
hair, and was very talkative personality. He was working for
a political party and was involved in multiple social activities.
Since he was always engaged in public dealing work day and
night, it was disturbing his daily routine.
CLINICAL FINDINGS
He had presented with complaints of chronic insomnia,
which was disturbing his daily routine for the last
six months. He was feeling tired and lethargic during day
time. He was usually yawning throughout the day and
always needed a break for a nap in the afternoon, but was
not able to have a sound sleep. He also had complained
of mental stress, headache, anxiety, fatigue, etc., on and
off for the last six months. He was not having any other
signicant past medical or surgical history. Citing some
apprehensions about conventional medicine, the patient
reported to the Ayurveda institution for management.
His academic performance was poor, while having a
keen interest in sports, and had good and satisfactory
communication skills. The patient had no history of drug
abuse, tobacco, smoking, or alcohol intake. In his family,
there was no history of diabetes, hypertension, cardiac
disease, or neurological or psychological disease. There
was no history of any bad incidence that might affect his
mental health.
DIAGNOSTIC ASSESSMENT
On taking case history, chances of some psychological
stress precipitating insomnia were noted. The patient was
evaluated for subjective assessment with PSQI[9] for his
sleep quality and the PSS[10] score to measure the stress
level at the baseline. HRV readings were taken using a
smartphone HRV camera app at baseline.[11]
Heart Rate Variability
HRV refers to the variation in time between consecutive
heartbeats. It is a noninvasive measure of the autonomic
nervous system’s control over the cardiovascular system
and is an indicator of overall health and well‑being. HRV
was measured through the validated mobile application
HRV Camera v0.92 by the investigator’s smartphone.
HRV Camera v0.92 is a mobile application that uses a
camera to measure HRV through changes in skin color.
HRV camera uses automatic adaptive bandwidth ltering
accompanied by discrete energy separation to evaluate
the prompt frequencies. Root Mean Square of Successive
Differences (RMSSD) and standard deviation of interbeat
intervals metrics are computed from pulse intervals. The
validation of computed metrics was done against manually
calculated metrics.[11] More attention to wearable portable
technologies, the smartphone offers a cost‑adequate
substitute to the traditional way of ambulatory monitoring..[12]
This application provides a platform to understand, track,
and monitor cardiac parameters. To assess HRV, a user
has to put his/her nger to cover the camera lens of
smartphone completely. The camera preview should be
red and real‑time graph should display a quasi‑periodic
signal during capturing records for at least one min. The
nger pulp should be in optimal position not to be heated
up by the ashlight.
Perceived Stress Scale score
The PSS score is a validated questionnaire‑based
self‑administered scale to measure mental stress. It is scored
from 0 to 40 value scale. Low stress is 0–13 score, moderate
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Javed, et al.: Shirodhara and Abhyanga improves mental and cardiac health
Journal of Ayurveda Case Reports - Volume 6, Issue 2, April-June 2023 47
stress score is 14–26, and high perceived stress is scored
27–40 score. PSS score was calculated considering the
responses given by the patient and using online resource.[13]
Pittsburgh Sleep Quality Index
The PSQI is also a validated online self‑administered
questionnaire tool to assess the quality of sleep. PSQI
contains seven different domains of subjective sleep quality,
sleep latency, sleep duration, habitual sleep efciency,
sleep disturbances, use of sleep medication, and daytime
dysfunction. PSQI calculation was also done using online
resource.[14]
TIMELINE
The patient was given the AETM therapy for a total ten days
on the consecutive days during September 2021. HRV was
assessed after each sitting. PSS and PSQI were evaluated on
the baseline and after completing 10 days of AETM sittings.
THERAPEUTIC INTERVENTION
Considering complaints and apprehensions of the patient
toward oral medication, any herbal medicine for oral
intake was not prescribed. After receiving due consent
from the patient, ten days of AETM sittings were
provided [Table 1]. Shirodhara with Brahmi taila and Tila
taila (~sesame oil) in the ratio 1:3, Sarvanga abhyanga with
Maha vishgarbha taila and Sarvanga swedana with medicated
steam using Dashamoola kwatha (~decoction of Dashmoola),
Nagakeshara (Mesua ferrea L.), Nirgundi (Vitex negundo L.),
Dhaturapatra (Datura stramonium L.), Tejpatra [Cinnamomum
tamala (Buch.‑Ham.) T. Nees and Eberm.] was given
by trained and experienced masseur in a well‑equipped
Panchakarma therapy room. Temperature of the treating
oil was maintained at 42°C ± 2°C with the help of a digital
thermometer. Light vegetarian diet and abstinence from
social media were advised during the course of treatment.
FOLLOW-UP AND OUTCOME
Heart Rate Variability
HRV of the patient was observed at baseline just before and
after each session of AETM. The readings of the 4th and
6th days could not be taken due to non‑compliance of the
patient. Breathing pattern was 4:2:5:2 (inspiration: pause:
expiration: pause) in all readings. During ten days, his Heart
Rate (HR) and HRV were improved. HR was lower than
the resting HR (RHR) for cardio calculations; r update
RHR with HR in this record [Table 2].
Perceived Stress Scale score
At baseline, PSS score was recorded as “27” with the
interpretation of “high” perceived stress. After treatment,
this score was reduced to a score of “12,” which represents
“mild” perceived stress [Graph 1].
Pittsburgh Sleep Quality Index
Initially, the overall score for sleep quality was very poor,
with Global PSQI “13” as baseline. This was reduced and
observed to be inferring that the sleep quality is highly
improved after the management [Table 3 and Graph 1].
DISCUSSION
In this case study, the beneficial effect of Ayurvedic
traditional massage, steam bath, and Shirodhara on
cardiovascular and autonomic parameters along with the
effects on sleep and mental stress was observed. Studies
on the impact of Abhyanga swedana on cardiovascular and
autonomic variables in patients are very limited. In the old
ages, Abhyanga was an indistinguishable piece of daily life
due to its enormous advantages to the human body, making
it challenging and liberated from illness. However, with
time‑evolving quickly, Abhyanga has overall notoriety as an
Ayurvedic massage or spa. Around 250 kinds of massage
therapies are accessible everywhere in the world.[15] Ayurveda
has its own remain on the signicance of Abhyanga.
AETM sessions resulted in decrease in mental stress
evaluated by perceived stress score. Similar results were
found in a study where autonomic nervous system was
evaluated over 139 subjects treated by heat and massage
application for 40 min, ve days a week for two weeks.
Serum cortisol levels and plasma norepinephrine levels
were signicantly decreased. HR and latency increased and
Table 1: Ayurvedic Panchakarma Therapy Module
Procedure Material Duration (min)
Shirodhara Brahmi taila + Tila taila (1:3) 30
Sarvanga abhyanga Maha vishgarbha taila 20
Sarvanga swedana Dashamoola kwatha,
Nagakeshara, Nirgundi,
Dhaturapatra, Tejpatra (5:1:1:1:1)
10
Graph 1: Changes in global PSQI score and PSS score. PSQI:
Pittsburgh Sleep Quality Index, PSS: Perceived Stress Scale
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Javed, et al.: Shirodhara and Abhyanga improves mental and cardiac health
48 Journal of Ayurveda Case Reports - Volume 6, Issue 2, April-June 2023
amplitude decreased signicantly compared to baseline.[16]
The patient reported here was having normal blood pressure
at baseline and the end. However, in an in vivo rat model
experimental study, calibrated massage technique was found
effective in reducing Systolic Blood Pressure (SBP).[17]
While another randomized exploratory pilot trial showed
a signicant decrease in cortisol in the mechanical massage
group of 93 Swedish employees, but no significant
change was seen in HRV and SBP parameters.[18] Root
Mean Square of Successive Differences (RMSSD) is a
strong overall fitness level indicator. Low‑Frequency
(LF) and High‑Frequency (HF) ratio in HRV frequency
domain suggests the activation of the parasympathetic
or sympathetic system on cardiac rhythm. Although in
the present case report, the parasympathetic shift of the
frequency domain of HRV was noticed, the results may
not be conclusive at this stage. However, an exploratory
study of twenty healthy adult participants who received
the moderate pressure massage exhibited an increase
in HF, suggested increased vagal efferent activity, and a
decrease in the low to high‑frequency ratio, suggesting
a shift from sympathetic to parasympathetic activity.[19]
Normal HR at rest for adults varies from 40 to 70 beats/
min. A lower RHR infers more efcient heart function and
better overall tness. HRV is the measure of variations
present between consecutive heartbeats. HRV is regulated
by our autonomic nervous system. It reects our response
to stressful situations such as ght‑or‑ight. It is mainly
controlled by brain. Brain affects the variations present
between regular heartbeats.
Any type of musculoskeletal pain also increases stress in
the human brain. This stress also affects the cardiovascular
parameters. Immediate effects of Traditional Thai massage
were evaluated with 30 min each session in 36 patients
with back pain associated with myofascial trigger points,
demonstrated a signicant increase in HRV (increased both
total power frequency and HF), pressure pain threshold,
body exibility, signicant decreases in self‑reported pain
intensity, anxiety, and muscle tension.[20] Similar results were
found in a pilot study in which twenty healthy subjects
showed the positive effects of Ayurvedic Abhyanga massage
on subjective stress experience, HR, and blood pressure.[21]
The present case report has also shown similar ndings;
however, the Shirodhara procedure is additional in the
current study. Abhyanga has been reported benecial in
some other conditions like burn scar tissues.[22] Massage
over calf muscles has also been found to increase ankle
joint exibility and improves balancing.[23,24]
In this case report, the combination of Shirodhara
and Abhyanga has been found to contribute to
Table 2: Heart Rate Variability
Baseline Day 1 Day 2 Day 3 Day 5 Day 7 Day 8 Day 9 Day 10
BP (mmHg) 101/74 110/74 105/72 110/ 74 105/72 106/73 110/79 111/75 106/74
HR (bpm) (%) 98 95 101 81 77 103 102 94 63
HRV (ms) (%) 15 (13) 24 (37) 23 (34) 26 (43) 28 (48) 54 (86) 65 (91) 110 (98) 88 (96)
Time domain
RR average 611 629 589 734 778 577 587 633 1123
rMSSD 15 24 23 26 28 54 65 110 88
SDSD 15 24 22 26 27 54 63 110 87
SDNN 15 167 215 51 23 85 158 98 261
pNN50 0 6 5 0 6 33 58 65 31
Frequency domain
LF (ms2)14 341 1003 77 2 357 2537 2397 161
HF (ms2) 4 5 8 25 19 43 19 3 387 0
LF/HF ratio 3.50 68.20 125.38 3.08 0.11 8.30 13 .15 6 .19 ‑
LF nu 78 96 97 74 11 89 91 85 99
HF nu 22 1 1 24 89 11 714 ‑
Overall outcome Poor Normal Normal Normal RFI Good Good Good Excellent
rMSSD: The square root of the mean of the sum of the squares of differences between adjacent NN intervals, SDNN: Standard deviation of all
NN intervals, pNN50: NN50 count divided by the total number of all NN intervals, LF: Low frequency in normalized units, HF: High frequency in
normalized units, BP: Blood pressure, HR: Heart rate, HRV: HR variability, SDSD: Standard deviation of successive differences, RFI: Room for
improvement
Table 3: Pittsburgh Sleep Quality Index
Component BT AT
Subjective sleep quality 3 1
Sleep latency 2 1
Sleep duration 2 1
Habitual sleep efficiency 3 3
Sleep disturbances 1 0
Use of sleep medication 0 0
Daytime dysfunction 2 1
BT: Before treatment, AT: After treatment
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Javed, et al.: Shirodhara and Abhyanga improves mental and cardiac health
Journal of Ayurveda Case Reports - Volume 6, Issue 2, April-June 2023 49
healthy living. An improvement in cardiovascular and
psychoneurological parameters in the subject was
noticed. Regular practice of Shirodhara and Abhyanga
can promote well‑being by reducing stress levels and
improving sleep and HRV.[25]
Limitations and recommendations
This was a single case report, so it is very difcult to
conclude the results of this study. However, this study
indicates that AETM sittings are helpful for general
well‑being. One of the major limitations of this study was
HRV readings. The duration of HRV records taken through
mobile application was very short, i.e., 30–60 s, which is
having less accuracy. Electrocardiogram recordings of more
than three min with an HRV monitor are recommended
for more accurate readings.
CONCLUSION
It is clear from the study that AETM sittings including
Shirodhara, Sarvanga abhyanga, and Sarvanga swedana were found
effective to reduce mental stress and improving sleep quality
and cardiovascular and autonomic functions. The methods
used in this study should be further evaluated as a preventive
and rehabilitative cardiology approach in Ayurveda.
Patient perspective
The patient was pleased after getting diminution in most
of the symptoms.
Declaration of patient consent
The authors certify that they have obtained patient
consent form, where the patient has given his consent for
reporting the case along with the images and other clinical
information in the journal. The patient understands that
his name and initials will not be published and due efforts
will be made to conceal his identity, but anonymity cannot
be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
REFERENCES
1. Ali T, Belete H, Awoke T, Zewde F, Derajew H, Yimer S, et al. Insomnia
among town residents in Ethiopia: A community‑based cross‑sectional
survey. Sleep Disord 2019;2019:1‑7.
2. Radhakrishnan R, Andrade C. Suicide: An Indian perspective. Indian
J Psychiatry 2012;54:304‑19.
3. Chadda RK. Caring for the family caregivers of persons with mental
illness. Indian J Psychiatry 2014;56:221‑7.
4. Esch T, Stefano GB, Fricchione GL, Benson H. Stress in cardiovascular
diseases. Med Sci Monit 2002;8:A93‑101.
5. Gupta A, Wang Y, Spertus JA, Geda M, Lorenze N, Nkonde‑Price C,
et al. Trends in acute myocardial infarction in young patients and
differences by sex and race, 2001 to 2010. J Am Coll Cardiol
2014;64:337‑45.
6. Singh RH, Narsimhamurthy K, Singh G. Neuronutrient impact
of Ayurvedic Rasayana therapy in brain aging. Biogerontology
2008;9:369‑74.
7. Allgulander C. History and current status of sedative‑hypnotic drug
use and abuse. Acta Psychiatr Scand 1986;73:465‑78.
8. Dhuri KD, Bodhe PV, Vaidya AB. Shirodhara: A psycho‑physiological
prole in healthy volunteers. J Ayurveda Integr Med 2013;4:40‑4.
9. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ.
The Pittsburgh sleep quality index: A new instrument for psychiatric
practice and research. Psychiatry Res 1989;28:193‑213.
10. Pangtey R, Basu S, Meena GS, Banerjee B. Perceived stress and its
epidemiological and behavioral correlates in an Urban Area of Delhi,
India: A community‑based cross‑sectional study. Indian J Psychol Med
2020;42:80‑6.
11. Pai A, Veeraraghavan A, Sabharwal A. HRVCam: Robust camera‑based
measurement of heart rate variability. J Biomed Opt 2021;26:022707.
12. Holmes CJ, Fedewa MV, Winchester LJ, MacDonald HV, Wind SA,
Esco MR. Validity of smartphone heart rate variability pre‑ and
post‑resistance exercise. Sensors (Basel) 2020;20:5738.
13. Available from: https://www.mdapp.co/perceived‑
stress‑scale‑pss‑calculator‑389/at17:01. [Last accessed on 2023 Apr 03].
14. Available from: https://qxmd.com/calculate/calculator_603/
pittsburgh‑sleep‑quality‑index‑psqi/at 17:05. [Last accessed on
2023 Apr 03].
15. Vickers A, Zollman C. ABC of complementary medicine. Massage
therapies. BMJ 1999;319:1254‑7.
16. Lee YH, Park BN, Kim SH. The effects of heat and massage application
on autonomic nervous system. Yonsei Med J 2011;52:982‑9.
17. Spurgin KA, Kaprelian A, Gutierrez R, Jha V, Wilson CG, Dobyns A,
et al. A calibrated method of massage therapy decreases systolic blood
pressure concomitant with changes in heart rate variability in male rats.
J Manipulative Physiol Ther 2017;40:77‑88.
18. Van Dijk W, Huizink AC, Müller J, Uvnäs‑Moberg K,
Ekström‑Bergström A, Handlin L. The effect of mechanical massage
and mental training on heart rate variability and cortisol in Swedish
employees‑a randomized explorative pilot study. Front Public Health
2020;8:82.
19. Diego MA, Field T. Moderate pressure massage elicits a parasympathetic
nervous system response. Int J Neurosci 2009;119:630‑8.
20. Buttagat V, Eungpinichpong W, Chatchawan U, Kharmwan S. The
immediate effects of traditional Thai massage on heart rate variability
and stress‑related parameters in patients with back pain associated with
myofascial trigger points. J Bodyw Mov Ther 2011;15:15‑23.
21. Basler AJ. Pilot study investigating the effects of Ayurvedic Abhyanga
massage on subjective stress experience. J Altern Complement Med
2011;17:435‑40.
22. Ault P, Plaza A, Paratz J. Scar massage for hypertrophic burns
scarring‑A systematic review. Burns 2018;44:24‑38.
23. Park J, Shim J, Kim S, Namgung S, Ku I, Cho M, et al. Application
of massage for ankle joint exibility and balance. J Phys Ther Sci
2017;29:789‑92.
24. Capobianco RA, Mazzo MM, Enoka RM. Self‑massage prior to
stretching improves exibility in young and middle‑aged adults. J Sports
Sci 2019;37:1543‑50.
25. Tokinobu A, Yorifuji T, Tsuda T, Doi H. Effects of Ayurvedic
oil‑dripping treatment with sesame oil versus with warm water on
sleep: A randomized single‑blinded crossover pilot study. J Altern
Complement Med 2016;22:52‑8.
[Downloaded free from http://www.ayucare.org on Friday, June 30, 2023, IP: 244.128.24.184]